Inferior Vena Cava Leiomyosarcoma: Is Reconstruction Necessary after Resection?
Inferior Vena Cava Leiomyosarcoma: Is Reconstruction Necessary after Resection?
复制标题
DOI：
10.1016/j.jamcollsurg.2009.10.010
复制
发表时间：
2010-02-01
影响因子：
5.2
通讯作者：
Khatri, Vijay P.
中科院分区：
文献类型：
--
作者：
Daylami, Rouzbeh;Amiri, Amir;Khatri, Vijay P.
背景：下腔静脉平滑肌瘤是一种罕见的软组织肉瘤。由于经验有限，管理战略必然会有所不同。多模态治疗和IVC重建的必要性的问题仍然存在。研究设计：6例患者被称为我们的机构在6年的IVC平滑肌瘤。人口统计学资料，影像学结果，病理报告，术前放射治疗方案，术后结果进行了审查。结果进行了比较，与其他出版的机构experience.Results：术前外束放射（4,500至5,000 cGy）后，所有患者进行了整块切除原发性恶性肿瘤。4例患者（66%）行R 0切除术。所有肿瘤均为高级别。未进行IVC重建。3例患者（50%）出现下肢水肿，但耐受性良好，未导致任何长期后遗症。1例患者（17%）术后发生肺转移，并通过化疗和转移切除术成功治疗。3例患者发生急性肾功能衰竭，但均恢复完全功能。乳糜漏2例（34%）。结论：IVC平滑肌肉瘤是一种可治疗的恶性肿瘤。虽然我们的研究规模太小，不能证明术前外照射对生存的益处，但术前外照射有助于轻微阴性切除。在大多数情况下，如果不是所有病例，下腔静脉重建对于切除肝静脉水平以下的肿瘤是不必要的。下腔静脉结扎后下肢水肿耐受良好。急性肾衰竭是一种常见的术后早期并发症，尽管是短暂的。广泛的主动脉周围夹层可伴有乳糜漏，可采用内引流或外引流治疗。（美国科尔外科杂志2010;210：185-190。(C)2010年美国外科医生学会）
BACKGROUND: Leiomyosarcomas of the inferior vena cava represent a rare form of soft-tissue sarcomas. Management strategies necessarily vary because of limited experience. Questions about necessity of multimodality therapy and IVC reconstruction remain.STUDY DESIGN: Six patients were referred to our institution during a period of 6 years for leiomyosarcomas of the IVC. Demographic data, imaging results, pathology reports, preoperative radiation regimen, and postoperative outcomes were reviewed. Outcomes were compared with those of other published institutional experiences.RESULTS: After preoperative external-beam radiation (4,500 to 5,000 cGy), all patients underwent en bloc resection of the primary malignancy. Four patients (66%) had an R0 resection. All tumors were high grade. No reconstruction of the IVC was undertaken. Lower-extremity edema developed in 3 patients (50%), but this was well tolerated and did not lead to any long-term sequelae. Pulmonary metastasis developed postoperatively in 1 patient (17%) and was successfully treated with chemotherapy and metastectomy. Acute renal failure developed in 3 patients, but all recovered full function. Chylous leak developed in 2 patients (34%).CONCLUSIONS: Leiomyosarcoma of the IVC is a treatable malignancy. Preoperative external-beam radiation facilitates marginally negative resection, although our study is too small to demonstrate a survival benefit. Reconstruction of the IVC is not necessary for resection of tumors below the level of the hepatic veins in most if not all cases. Lower-extremity edema after ligation of the IVC is well tolerated. Acute renal failure can be a common, albeit transient, early postoperative complication. Extensive periaortic dissection can be associated with chylous leak, which can be managed with internal or external drainage. (J Am Coll Surg 2010;210:185-190. (C) 2010 by the American College of Surgeons)